ADVOCACY CMS Finalizes Regulatory Changes and Updates Physician Payment System Each year, the Centers for Medicare & Medicaid Services (CMS) issues regulations that impact the reimbursement of physicians. On November 2, 2021, CMS finalized a rule updating payment policies and rates for physicians paid under the Medicare Physician Fee Schedule in 2022. The final rule illustrates the importance of the AAN’s regulatory advocacy efforts on behalf of neurologists and their patients. CMS expects payments across the specialty of neurology to stay at current levels in 2022, with variations depending on the individual provider’s practice. However, all specialties are also potentially facing a 3.7-percent reduction in the conversion factor used to formulate payments under the Medicare Physician Fee Schedule. The AAN is working with physician associations from across the house of medicine to fight against these potential cuts, which recently resulted in having 247 members of the US House of Representatives sign a letter urging congressional leaders to act on this issue before the end of the year.
Evaluation and Management (E/M) Visits Like in previous years, CMS continues its ongoing review of E/M code sets. The AAN remains highly supportive of the new coding and payment structure implemented on January 1, 2021, and lauds the agency for moving forward with implementation. For 2022, the agency is refining several policies to align with the revised E/M visit codes guidelines which took effect January 1, 2021. Four new principal care management codes will be available for neurologists to use in 2022, recognizing the comprehensive services provided for a single high-risk disease. CMS is refining its policies for split or shared E/M visits to reflect the evolving role of advanced practice providers (APP) and changes to the practice of medicine. For 2022, CMS defines split or shared E/M visits as those provided in the facility setting by a physician and an APP in the same group and expands to include new patient encounters. CMS has decided on a new, time-based definition of the “substantive portion” of a visit that must be furnished by the physician to bill split (shared), but this change will not be implemented until 2023, as the AAN requested.
Telehealth Regulations As expected, the final rule codified that the telehealth services added to the Medicare telehealth services list under the temporary “category 3” during the COVID-19 public health emergency (PHE) be removed from the list after the PHE ends. These services will have to be submitted to be made permanent under either category 1 or 2. However, CMS acknowledges that there has not been sufficient time to collect the utilization
data needed on these telehealth services for submission and approval. Therefore, CMS will retain all telehealth services added due to the PHE through calendar year 2023 so that they can be analyzed and submitted for the 2023 and 2024 fee schedules for permanent inclusion. This is a welcome decision by CMS as it gives providers a clear timeframe during which they can continue to use these temporarily approved telehealth services and allows for the much-needed study of these services for their potential permanent inclusion. The AAN was glad to see that CMS accepted our recommendation that the requirement for an in-person visit every six months to be reimbursed for telehealth services be raised to a 12-month period. This will relieve an undue obstacle to the continuation of care provided via telehealth. CMS also finalized its proposal to allow another physician in the same specialty and practice to fulfill this requirement should the original physician be unavailable, as the AAN requested. CMS has finalized the change to the requirements of telehealth provision to permanently allow audio-only telehealth services for the diagnosis, evaluation, or treatment of mental health disorders when the patient’s home is the originating site. Only providers who are set up to provide full audio/visual telehealth services can make use of audio-only services; this is to ensure that it is the patient’s aversion or inability to use audio/ visual services that leads to an audio-only visit. The AAN was supportive of this change as it represents a logical adjustment of regulation to match the incorporation of technology in the provision of care.
Appropriate Use Criteria CMS will delay the beginning of the payment penalty phase of the Appropriate Use Criteria (AUC) program to no sooner than January 1, 2023, or the January 1 that follows the declared end of the COVID-19 Public Health Emergency. The flexibilities offered by CMS are intended to consider the impact
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AANnews • December 2021
